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\s=b\ We studied the effects of laparoscopic cholecystectomy on respiratory and hemodynamic function in eight adult pigs. Minute ventilation was adjusted to normalize baseline arterial blood gases, then fixed throughout carbon dioxide insufflation. A metabolic measurement cart recorded total CO2 excretion, oxygen consumption, and minute ventilation. Carbon dioxide pneumoperitoneum was maintained at a constant pressure of 15 mm Hg as cholecystectomy was performed. After 1 hour of insufflation, CO2 excretion increased from 115\m=+-\10mL/min to 149\m=+-\9mL/min but O2 consumption remained unchanged. The PaCO2 increased from 35\m=+-\2mm Hg to 49\m=+-\3mm Hg and arterial pH fell from 7.47\m=+-\0.02to 7.35\m=+-\0.03. Systemic and pulmonary hypertension occurred and stroke volume dropped from 35.5\m=+-\3.5mL to 28.6\m=+-\2.2mL with compensatory tachycardia. Right atrial pressure remained unchanged as inferior vena cava pressure increased to reflect the intraperitoneal pressure. We conclude that CO2 pneumoperitoneum resulted in significant transperitoneal CO2 absorption, with secondary hypercapnia and acidemia. The accumulation of CO2 was also associated with an increase in systemic and pulmonary arterial pressure. Heart rate increased to compensate for the decreased stroke volume to maintain cardiac output. (Arch Surg. 1992;127:928-933) Laparoscopi e cholecystectomy is a recent, but exciting, . development in the surgical management of chole¬ lithiasis, as it removes the target organ and yet, avoids the traditional large upper abdominal incision with the asso¬ ciated postoperative pain, disability, and slow return to work. Since the first procedure was performed in France in 1987, laparoscopie cholecystectomy has become popular in the United States.1-2 Although the procedure has enjoyed a minimal morbidity similar to that of open cholecyst¬ ectomy,2"4 reports on complications with ventilatory status such as hypercapnia or acidemia have appeared. Critical analysis of our experience with the first 381 patients at the University of California Davis Medical Center, Sacra¬ mento, and its affiliated hospitals revealed a comparable mortality and morbidity with the open procedure. Techni¬ cal complications occurred in 2% of the patients; nontech¬ nical complications occurred in 4% of patients. The most common nontechnical complication was atelectasis or pneumonia in five patients. One patient with a history of chronic obstructive pulmonary disease experienced severe hypercapnia following intraperitoneal carbon dioxide in¬ sufflation. She was subsequently converted to an open procedure owing to technical reasons, but the hypercapnia persisted postoperatively, requiring 24 hours of mechan¬ ical ventilation.5 Wittgen et al6 also reported that patients with preoperative cardiac or pulmonary disease experi¬ enced significant accumulation of arterial C02 and devel¬ opment of acidemia during the C02 insufflation period. One of these patients also required conversion to open cholecystectomy because of refractory acidemia.6 Liu et al...

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